What Is Adrenal Fatigue?
Adrenal fatigue is a term used for a group of symptoms, such as tiredness, poor sleep and salt or sugar cravings, that some people blame on adrenal glands worn out by long-term stress. It is not an official medical diagnosis. The Endocrine Society says no scientific proof supports adrenal fatigue as a true medical condition.
The idea was proposed by James L. Wilson, a chiropractor and naturopath, in a 2001 book. A 2016 systematic review of 58 studies concluded there is no substantiation that adrenal fatigue is an actual medical condition.
The symptoms are real, though. Accepting a vague label can let their true cause go undiagnosed and untreated.
Adrenal Fatigue at a Glance
| Is it a medical diagnosis? | No. No endocrinology society recognizes it. |
|---|---|
| Proposed cause | A theory that long-term stress exhausts the adrenal glands. No evidence supports it. |
| Symptoms blamed on it | Tiredness, trouble sleeping or waking, salt and sugar cravings, relying on caffeine |
| Is it serious? | The label can delay diagnosis of a real problem. Unneeded adrenal hormone supplements can be dangerous. |
| Testing | No test can detect it. |
| What to do instead | See a clinician to look for real causes, such as anemia, thyroid disease, sleep apnea or depression |
What Symptoms Are Blamed on Adrenal Fatigue?
The symptoms blamed on adrenal fatigue are common, non-specific complaints that can come from many diseases or from a normal, busy life. They include:
- Tiredness and weakness
- Trouble falling asleep at night or waking up in the morning
- Cravings for salt and sugar
- Needing stimulants like caffeine to get through the day
What Do Supporters Say Causes Adrenal Fatigue?
Supporters of adrenal fatigue say long-term stress overworks the adrenal glands until they can't make enough hormones, but research doesn't back this up. The adrenal glands sit above the kidneys and make cortisol, which helps the body respond to stress. Mayo Clinic notes there is no evidence for this, and the Endocrine Society states that the adrenal glands do not lose function because of mental or physical stress.
Chronic stress can still cause tiredness and trouble sleeping, and over time it raises the risk of high blood pressure, heart disease, diabetes and depression.
What Can Cause Fatigue Instead?
Fatigue blamed on adrenal fatigue can come from many other causes, such as:
- Anemia or iron deficiency
- An underactive or overactive thyroid
- Depression or grief
- Sleep disorders, such as insomnia or obstructive sleep apnea
- Medicines, alcohol or drug use
- Diabetes, heart failure, or kidney or liver disease
- Adrenal insufficiency, a real hormone disorder
How Is Fatigue Evaluated Instead of Testing for Adrenal Fatigue?
There is no valid adrenal fatigue test, so a clinician evaluates fatigue by looking for its actual cause. A standard evaluation includes questions about your symptoms, habits and mood, and a physical exam. Tests may include blood tests for anemia, diabetes, inflammatory diseases and infection, plus kidney, liver and thyroid function tests and a urinalysis.
If adrenal insufficiency is suspected, early-morning (about 8 a.m.) blood levels of cortisol, corticotropin (ACTH) and DHEAS are checked. An ACTH stimulation test is the test used most often to confirm it.
Are Adrenal Fatigue Treatments and Supplements Safe?
Adrenal fatigue treatments are not approved by the FDA, and some can cause harm. Many "adrenal support" supplements have not been tested for safety, and their labels may not match what is inside.
- A Mayo Clinic study tested 12 over-the-counter adrenal support supplements. All contained thyroid hormone (T3), 42% contained pregnenolone, 25% contained the steroid budesonide and 8% contained cortisol.
- Taking adrenal hormones you don't need can make your own adrenal glands stop working. They can stay "asleep" for months after the supplements are stopped, risking a life-threatening adrenal crisis.
What Helps Symptoms Blamed on Adrenal Fatigue?
Treatment for symptoms blamed on adrenal fatigue depends on what is actually causing them. The Endocrine Society notes that exercise, healthy eating and a regular sleep-and-wake routine almost always help people feel better, whatever the diagnosis. MedlinePlus also advises avoiding alcohol, nicotine and drug use. Caffeine and other stimulants are not effective treatments for fatigue and can make it worse when stopped.
Adrenal Fatigue vs. Adrenal Insufficiency
Adrenal fatigue is an unproven label, while adrenal insufficiency is a real disorder in which the adrenal glands don't make enough hormones.
| Adrenal fatigue | Adrenal insufficiency | |
|---|---|---|
| Recognized condition? | No | Yes |
| Cause | Claimed to be chronic stress | Adrenal damage (Addison's disease, usually autoimmune), pituitary problems, or suddenly stopping long-term corticosteroids |
| How common | Not applicable; it isn't a recognized condition | Addison's disease is rare, affecting about 100 to 140 per million people in developed countries. Adrenal insufficiency caused by steroid medicines is common. |
| Symptoms | Tiredness, poor sleep, cravings | Long-lasting fatigue, muscle weakness, weight loss, belly pain, dizziness on standing, salt craving |
| Testing | No valid test | Blood cortisol and ACTH tests, ACTH stimulation test, imaging |
| Treatment | No proven treatment | Daily hormone replacement, which may be lifelong |
When Should You See a Clinician About Adrenal Fatigue Symptoms?
See a clinician about adrenal fatigue symptoms when fatigue isn't relieved by enough sleep, good nutrition and lower stress. Make an appointment if you:
- Always feel tired or weak, or are losing weight without trying
- Have fatigue with fever or sweats
- Feel sad or depressed, or have insomnia
- Take medicines that may cause fatigue (don't stop or change any medicine on your own)
Severe nausea and vomiting, diarrhea, belly pain, confusion or fainting can be warning signs of adrenal crisis, especially if you have adrenal insufficiency or recently stopped long-term steroids. Adrenal crisis can be life-threatening, so get emergency care right away.
Adrenal Fatigue Evaluation at GENEVA
At GENEVA Primary Care & Med Spa in Alpharetta, GA, a provider evaluates ongoing fatigue to look for a treatable cause. Based on that evaluation, your provider recommends treatment at GENEVA or a referral to a specialist, such as an endocrinologist.
You can raise these concerns during a primary care visit or an annual physical exam. GENEVA serves patients from Alpharetta, Johns Creek, Milton, Roswell and Cumming.
Related Terms
Adrenal Fatigue FAQs
Is adrenal fatigue a real medical condition?
No. Adrenal fatigue is not a recognized medical diagnosis, and the Endocrine Society says no scientific proof supports it as a true condition. A 2016 systematic review screened 3,470 articles, analyzed 58 studies and found no substantiation that adrenal fatigue is an actual medical condition. The symptoms people describe, such as tiredness and poor sleep, are real and common. Because the label can hide the true cause, lasting symptoms should be checked by a clinician.
Can a saliva or blood test diagnose adrenal fatigue?
No. No test can detect adrenal fatigue, and the saliva and blood tests sometimes offered for it are not supported by good scientific studies. Adrenal fatigue testing usually relies on nonvalidated online surveys and salivary cortisol profiles. Real adrenal problems are diagnosed with validated tests, such as early-morning blood cortisol, ACTH and DHEAS levels and an ACTH stimulation test. If you're worried about your adrenal glands, ask a clinician about these standard tests.
Are adrenal fatigue supplements safe?
Adrenal fatigue supplements may not be safe, because many have not been tested and their labels may not match their contents. In a Mayo Clinic study of 12 over-the-counter adrenal support supplements, all contained thyroid hormone (T3) and 25% contained the steroid budesonide. Taking adrenal hormones you don't need can shut down your own adrenal glands for months after stopping, risking a life-threatening adrenal crisis. Talk to a clinician before taking or stopping any adrenal supplement.
What is the difference between adrenal fatigue and adrenal insufficiency?
Adrenal fatigue is an unproven label, while adrenal insufficiency is a real, testable disorder in which the adrenal glands don't make enough hormones such as cortisol. Adrenal insufficiency causes long-lasting fatigue, muscle weakness, weight loss and dizziness on standing. Addison's disease affects about 100 to 140 per million people in developed countries. The most common cause of adrenal insufficiency overall is suddenly stopping corticosteroids after long-term use. Treatment is daily hormone replacement, which may be needed for life.
How can I get my energy back without adrenal fatigue treatments?
Healthy daily habits help most people feel better, whatever is causing their tiredness. The Endocrine Society notes that exercise, healthy eating and a regular sleep-and-wake routine almost always improve how people feel. MedlinePlus adds avoiding alcohol, nicotine and drugs, relaxation such as yoga or meditation, and reducing stressors where possible. Caffeine and other stimulants don't treat fatigue and can make it worse when stopped. If fatigue persists despite rest, good nutrition and less stress, see a clinician.
Can a primary care provider diagnose adrenal fatigue?
No clinician can diagnose adrenal fatigue, because there is no valid test for it, but a primary care provider can evaluate the symptoms and look for their real cause. At GENEVA in Alpharetta, your provider evaluates your symptoms, then recommends treatment at GENEVA or a referral to a specialist. Fatigue tests may include blood tests for anemia, plus thyroid, kidney and liver tests. If adrenal insufficiency is suspected, an endocrinologist should confirm it.